What is your ethnicity? If American Indian or Alaska Native, what tribe are you a part of? If Urban indicate below
Do you currently have a primary care physician / doctor?
Do you currently have health insurance?
Does your insurance status prevent you from seeking health services?
Have you ever used alcohol or illicit substances before?
If Yes To Either At What Age
How easy is/ was it for you to get alcohol or illicit substances in your community when under age (under 21)
How many alcoholic beverages have you consumed in the last 30 days
Do you have a family history of diabetes
Have you ever had suicide ideations or actions
Do you know where to go or who to contact if you or a friend is having thoughts on Suicide? You can always call 988, the Suicide and Crisis Line for Support
Have you ever been a victim of a crime including domestic or intimate partner violence
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